| NPI | 1649690314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR AT4555) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00651800) |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2021-06-14 |